All Good Things...This chapter has explored the value of team building and teamwork in health care.. Coordination of care occurs best with teamwork, and the elements of good teamwork inc
Trang 1All Good Things
This chapter has explored the value of team building
and teamwork in health care The innumerable
numbers and types of health-caregivers create
potential for chaos and require coordination of care
for patient safety Coordination of care occurs best
with teamwork, and the elements of good teamwork
include good communication and good group work
Effective communication is based on intentional
application of good sending and receiving
tech-niques Effective group work occurs when group
members understand group structure and process
and are committed to achieving group goals Groups
grow through stages of development; those that are
highly developed become productive teams The
best teams have effective leaders, excellent
commu-nication, group loyalty, clear goals, flexibility,
com-petence, and members who care about each other
Teams are the cornerstone of high-quality patient
care and satisfying work environments
Let’s Talk
1. Think about the various health-care workers you
have met How well informed do you feel about the roles they fill? How does the nursing role differ from the respiratory therapist role? How are they the same? How could you find out more about their role and the roles of other health-care disciplines?
NCLEX Questions
1. The situation that best exemplifies why nurses
must be skilled in functioning as an
interdisci-plinary team member is:
A Nurses are frequently expected to serve as a
team leader on their nursing unit, which may include several levels of nurse caregivers
B Most practicing nurses are expected to be a
member of or provide leadership for formal nursing committees
C Nurses must be prepared to participate in
nursing research groups to improve nursing care
D Most nurses function in hospitals that employ specialists from many different care-giver groups who must work together to pro-vide coordinated care
2. Pick the situation below that would provide the greatest opportunities for misunderstanding, friction, and conflict based on the concepts
described in this chapter.
A Ms Hassad, AS, RN; Mr Krank, CAN; and
Dr Arrington, ER physician, are applying a cast to Steven, a 4-year-old accident victim Steven’s mother, father, and grandparents are present The family is very anxious and watching to be sure that Steven receives the best care
B The staff members of the NICU (six BSN, RNs; two CNAs, one medical director, one surgical director, two respiratory therapists, two unit administrative assistants, one phar-macist, and one MSN nurse manager) are working as a team to lower the nosocomial infection rate on their unit
C Ms Carmen, BSN, RN, is a home health nurse caring for Mr Wolinski who lives alone and is very depressed, argumentative, and hard of hearing
D Six BSN nursing students enrolled in Nursing
301, Healthy Communities, have been assigned to work as a group to develop a teaching plan for smoking cessation
3. Which of the statements below best describes the relationship between nursing care, groups, and teams?
A Good teamwork is dependent on understand-ing how groups work
B Good nursing care is dependent on good teamwork, and good teamwork is dependent
on good group dynamics
C All three are equally important, and it is not necessary to understand their relatedness
D Good group work has nothing to do with good teamwork
4. All of the following groups are considered “for-mal” groups except:
A The nursing research committee of the NICU
B Nurses who are friends and have a walkers’ group at lunchtime
C Memorial Hospital Nursing Safety Committee
D The IRB of University Medical Center
198 Skills for Being an Effective Leader
Trang 25. Consider the following description of the NICU
staffing group in Question 2 above: All staff members have been employed on this unit and have been working together for at least 6 months
All the staff caregivers deliver conscientious quality care each day Part of their caregiving plan follows a special protocol that the group developed (based on research about nosocomial infections in the NICU) It includes careful hand-washing, careful adherence to sterile technique and universal precautions, careful adherence to proper equipment use, and careful observation of all caregiver behaviors to be sure they are aligned with agreed upon standards of care Disagree-ments occur and are discussed and resolved at team meetings When illness requires a change in staff workdays, someone volunteers to cover;
members celebrate holidays and birthdays; they
do their homework and they work together to screen new applicants for open positions to pro-tect the collaborative culture and effective care-giving model they have developed This group best exemplifies what stage of group develop-ment?
A Norming
B Forming
C Storming
D Performing
6. The critical importance of teamwork and
com-munication in health care has been documented
in many published reports These reports sup-port the positive association between effective teamwork and:
A Quality patient care
B Higher medication errors
C Compromised patient safety
D Lower staff morale
7. The best way to check to see if what you have
communicated has been understood the way you meant it to be is to use:
A Content and context clues
B Nonverbal communication
C Reliance on paralanguage
D Active listening and feedback
8. Effective communication is a cornerstone of
effective teamwork and it works best when those
involved are committed to all of the following
except:
A Utilizing mechanical techniques
B Attempting to suspend personal judgments
C Extending respect and positive regard for their teammates
D Utilizing excellent communication skills
9. Skills of good team leaders include all of the following except:
A Clearly defining the goal and providing frequent visual reminders of the goal
B Ignoring nonperformers and expecting others to do so
C Explaining how tasks or assignments will contribute to accomplishment of the goal and asking members to do the same
D Using frequent examples of how all contri-butions are moving toward the goal
10. When a team leader recognizes a need for improved technical expertise in the team, the leader may address this problem by:
A Demanding that the team members work harder to gain more knowledge and experi-ence in the necessary technical areas
B Sharing disappointment with the team and requesting that members solicit assistance from a colleague to help them become more competent
C Adding a new team member who is knowl-edgeable and can provide the team with strong consultation to assist other members
D Explaining to the employer that the team does not have the necessary knowledge and skills to meet the team goals
REFERENCES
Arnold, E., & Boggs, K (1995) Interpersonal Relationships (2nd
ed.) Philadelphia: W.B Saunders.
California Strategic Planning Committee for Nursing Retrieved September 9, 2004, from http://www.csuchico.edu/nurs/ levelsofnursed.htm
Burgoon, J.K., et al (1996) Deceptive realities: Sender, reviewer, and observer perspectives in deceptive conversations.
Communication Research, 23, 724–748.
Drinka, P., & Clark, P (2000) Health care teamwork:
Inter-disciplinary practice and teaching Westport, CT: Auburn
House.
Firth-Cozens, J (2001) Cultures for improving patient safety
through learning: The role of teamwork Quality in Health
Care, 10(Suppl II), 1126–1131.
Geriatric Interdisciplinary Team Training: A Curriculum from the Huffinton Center on Aging at Baylor College
of Medicine (2001) Long, D.M., & and Wilson, N.L (eds.) New York: John Hartford Foundation, Inc Retrieved Building Teams for Productivity and Efficiency 199
Trang 3November 5, 2004, from http://www.hospice.va.gov/Bronx/
module_3.htm
HealthGrades Quality Study (2004) Patient safety in American
hospitals HealthGrades, Inc.
Homans, G (1950) The human group New York: Harcourt
Brace Jovanovich.
Homans, G (1961) Social behavior: Its elementary forms New
York: Harcourt Brace.
Institute of Medicine (1999) To err is human: Building a safer
health system Washington, DC.: National Academy Press.
Kaissi, A., Johnson, T., & Kirschbaum, M (2003) Measuring
teamwork and patient safety attitudes of high risk areas.
Nursing Economics, 21(5), 211–218.
Lacoursiere, R.B (1980) The life cycle of groups: Group
devel-opment theory New York: Human Sciences Press.
LaFasto, R., & Larson, C (2001) When teams work best.
Thousand Oaks, CA: Sage.
Larson, C.E., & LaFasto, F.M.J (1989) Team work: What must go
right/what can go wrong Newbury Park, CA: Sage.
Majzun, R (1998) The role of teamwork in improving patient
satisfaction Group Practice Journal, 47.
McPherson, K., Headrick, L., & Moss, F (2001) Working and
learning together: Good quality care depends on it, but how
can we achieve it? Quality in Health Care, 2110(10): 47–53.
Nondestructive Testing (2004) Teamwork in the Classroom.
Retrieved October 29, 2004, from http://www.ndted.
org/TeachingResources/ClassroomTips/Teamwork.htm
Riley, J.B (2000) Communication in nursing (4th ed.) St Louis:
Mosby.
Risser, T.R., et al (1999) The potential for improved teamwork
to reduce medical errors in the emergency department Annals
of Emergency Medicine, 34(3): 373–383.
Rogers, C.R (1961) On becoming a person Boston: Houghton
Mifflin.
Schuster, P.A (2000) Communication: The key to the therapeutic
relationship Philadelphia: F.A Davis.
Sexton, J., Thomas, F., & Helmreich, R (2000) Error, stress, and teamwork in medicine and aviation: Cross sectional surveys.
British Medical Journal, 320, 745–749.
Silence kills: The seven crucial conversations for healthcare (2005) Retrieved July 2, 2005, at http://www.silencekills com
Stout, R., Salas, E., & Fowlkes, J (1997) Enhancing teamwork
to complex environments through team training Group
Dynamics: Theory, Research & Practice 1(2): 169–182.
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200 Skills for Being an Effective Leader
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Power, Politics,
and Policy
CAROLINE CAMUÑAS, EDD, RN
C H A P T E R M O T I V A T I O N
“ Never doubt that a small group of thoughtful, committed citizens can change the world; indeed it is the only thing that ever has ”
Margaret Mead
“ The ultimate measure of a person is not where one stands
in moments of comfort and convenience but where one stands
in times of challenge and controversy ”
Martin Luther King, Jr.
C H A P T E R M O T I V E S
■ To define power, politics, and policy
■ To investigate and discuss power, politics, and policy in relation
to nursing and health care
■ To examine outcomes of the workings of power, politics, and policy
■ To develop an understanding of how effective use of power, politics, and policy can enhance nursing and health care
201
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Trang 5Power, politics, and policy should be familiar
con-cepts for all nurses and are especially important for
nursing leaders Power, politics, and policy influence
nursing practice, education, and research, which in
turn influence health care Power and politics are
intricately entwined concepts and are sometimes
difficult to differentiate Both are used to achieve
ends or goals, and both do so through manipulation
of others Power and politics also interact People
who are powerful are able to exert more political
pressure; political success brings power that allows
people to accomplish goals through policy
develop-ment and impledevelop-mentation
Power is the ability to do or act; it is a state in
which one can manipulate others Politics is
negoti-ation for (scarce) resources; it is a process through
which one tries successfully or unsuccessfully to
reach a goal Policy is the “consciously chosen
course of action (or inaction) directed toward some
end” (Kalish & Kalish, 1982, p 61) Obtaining and
allocating resources are two examples of possession
and use of power They also exemplify the use of
pol-itics in that influence is needed to get what you want
and need Policies are guidelines that tell us how we
obtain and allocate those resources Understanding
power, politics, and policy is crucial to effective
patient care because these concepts have a
signifi-cant impact on access to care, allocation of funds,
and standards of care
Power
There are multiple definitions of power Some
assert that power is an overall concept that includes
authority and influence Others see authority and
influence as separate ideas or concepts; as such,
they require individual consideration Power is the
ability to influence other people despite their
resis-tance and may be actual or potential, intended or
unintended It may be used for good or evil, for
seri-ous purposes or for frivolseri-ous and selfish ones
Power is the ability to control, dominate, or
manip-ulate the actions of others or, as Rollo May stated,
“power is the ability to cause or prevent change”
(1972, p 99) It is a term used freely by politicians,
policy analysts, and many others Power is
impor-tant to nursing because having it is necessary to
achieve goals as individuals, professionals, and
lead-ers There are no definitive models of power, which often makes aspects of power complex and contra-dictory Power can shift; it is dynamic
There are a variety of sources (types or bases) of power that have been identified, as derived from the work of French and Raven (1959), Hersey, Blanchard, and Natemeyer (1979), Ferguson (1993), and Joel and Kelly (2002) Understanding sources of power facilitates analysis of individual and organi-zational behavior and enables prediction in specific situations Power sources or types are presented below
TYPES OR SOURCES
Power can be either positional and personal Posi-tional power is awarded or granted to a person, but
it is derived from a person’s position, office, or rank
in a formal organization system Personal power, on the other hand, is derived from followers Leaders who act in ways that are important to followers are given power An example is the nurse managers who have power because they are seen as highly competent, are good role models, or have some per-sonal attribute that makes them effective in their roles Expertise (which is discussed below) is a way
to gain personal power Common types of power include (a) authority, (b) expertise, (c) reward, (d) coercive, and (e) referent
Authority and Administrative
Administrative (sometimes called legitimate) or positional power requires that one serve in a line position and have responsibility for management and actions of other employees This kind of authority is given to a position rather than to a par-ticular person, for it is part of a role regardless of who fills that role For example, although the chief executive officer (CEO) in a health-care organiza-tion has the most power, the CEO is still answerable
to the board of trustees or directors The chief nurse executive (CNE) has the most power relative to the nurses who are situated further down the chart of the organization, such as supervisory staff, nurse managers, and staff nurses It is power accorded to
a person by virtue of the position held by that per-son Nurse managers and team leaders have more power than do staff nurses CNEs, deans, senators, mayors, governors, presidents, and other elected officials have administrative power
202 Skills for Being an Effective Leader